Psoriasis Treatment Considerations During Pregnancy

Contraindicated Treatments

• The American Academy of Dermatology recommends that acitretin is absolutely contraindicated during pregnancy due to its severe teratogenic effects, and women must avoid pregnancy for at least 3 years after discontinuing acitretin therapy 1, 2
• Acitretin causes severe fetal malformations and has a long elimination half-life, prompting the American Academy of Dermatology to advise women of childbearing potential to never receive acitretin 2, 3
• The American Academy of Dermatology states that methotrexate is absolutely contraindicated during pregnancy as it can cause fetal death or teratogenic effects, and women of childbearing potential must have pregnancy excluded before starting methotrexate 4, 5

Use with Caution During Pregnancy

• The American Academy of Dermatology recommends that cyclosporine should be used with caution during pregnancy, as it is pregnancy category C and may cause lower birth weight and shorter pregnancy duration, although it appears not to be teratogenic 1, 6
• Cyclosporine should only be used when the potential benefit justifies the potential risk to the fetus, and mothers receiving cyclosporine should not breastfeed 1, 6

Considerations for Treatment Selection During Pregnancy

• The American Academy of Dermatology suggests that for women planning pregnancy, systemic biologic therapies may be considered as safer alternatives to traditional systemic agents, though individual risk-benefit assessment is necessary 7
• When selecting treatments for women of childbearing potential, physicians must consider the risk of unplanned pregnancy and the teratogenic potential of medications, according to the American Academy of Dermatology 3, 8